Revisiting Brain Atrophy and Its Relationship to Disability in Multiple Sclerosis

Brain atrophy is a well-accepted imaging biomarker of multiple sclerosis (MS) that partially correlates with both physical disability and cognitive impairment.Based on MRI scans of 60 MS cases and 37 healthy volunteers, we measured the volumes of white matter (WM) lesions, cortical gray matter (GM), cerebral WM, caudate nucleus, putamen, thalamus, ventricles, and brainstem using a validated and completely automated segmentation method. We correlated these volumes with the Expanded Disability Status Scale (EDSS), MS Severity Scale (MSSS), MS Functional Composite (MSFC), and quantitative measures of ankle strength and toe sensation. Normalized volumes of both cortical and subcortical GM structures were abnormally low in the MS group, whereas no abnormality was found in the volume of the cerebral WM. High physical disability was associated with low cerebral WM, thalamus, and brainstem volumes (partial correlation coefficients ~0.3-0.4) but not with low cortical GM volume. Thalamus volumes were inversely correlated with lesion load (r = -0.36, p<0.005).The GM is atrophic in MS. Although lower WM volume is associated with greater disability, as might be expected, WM volume was on average in the normal range. This paradoxical result might be explained by the presence of coexisting pathological processes, such as tissue damage and repair, that cause both atrophy and hypertrophy and that underlie the observed disability

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Topology Correction of Segmented Medical Images using a Fast Marching Algorithm

We present here a new method for correcting the topology of objects segmented from medical images. Whereas previous techniques alter a surface obtained from a binary segmentation of the object, our technique can be applied directly to the image intensities of a probabilistic or fuzzy segmentation, thereby propagating the topology for all isosurfaces of the object. From an analysis of topological changes and critical points in implicit surfaces, we derive a topology propagation algorithm that enforces any desired topology using a fast marching technique. The method has been applied successfully to the correction of the cortical gray matter / white matter interface in segmented brain images and is publicly released as a software plug-in or the MIPAV package